Pressure test port contained within a body of surgical instrument

ABSTRACT

A surgical apparatus includes a housing, a test port retainer, a pressure test chamber, and an image capture assembly. The housing includes a pressure test port. The test port retainer includes a test port retainer housing, a probe seal, and a liquid exclusion barrier. In one aspect, the test port retainer also includes a hydrophobic membrane mounted within the test port retainer housing. The pressure test chamber includes a manifold and a central tube. The first end of the central tube is affixed to the image capture assembly to form a pressure seal, and the second end of the central tube is coupled to the test port retainer so that the pressure test port communicates with the interior volume of the central tube through the test port retainer.

RELATED APPLICATION

This application is a continuation of U.S. Ser. No. 16/317,698, filed onJan. 14, 2019, which is a national stage application filed under 35U.S.C. § 371 of PCT/US2017/031592 filed May 8, 2017, which claimspriority to and the benefit of: U.S. Provisional Patent Application No.62/362,188 entitled “A PRESSURE TEST PORT CONTAINED WITHIN A BODY OFSURGICAL INSTRUMENT,” and filed on Jul. 14, 2016, which is incorporatedherein by reference in its entirety.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention relates generally to endoscopes, and moreparticularly to features that facilitate testing and assembly of anendoscope.

Description of Related Art

One or more endoscopes are commonly used in computer-assisted surgery.An endoscope usually has a shaft, either flexible or rigid, that extendsinto a patient's body. At the end of the endoscope in the patient's bodyare one or more ports that provide illumination of the surgical site andone or more ports that are used to capture an image or images of thesurgical site. An electrical cable and a fiber optic cable typicallyextend through the shaft of the endoscope.

Since at least part of the endoscope is introduced into a patient's bodyduring a surgical procedure, the endoscope must be cleaned andsterilized before and after each surgical procedure. Typically, theendoscope is cleaned and disinfected by scrubbing the endoscope and thenplacing the endoscope in a bath and subjecting the endoscope toultrasound. The endoscope is sterilized by an autoclave process. In theautoclave process, the endoscope is subjected to a vacuum and to highpressure high temperature steam. Thus, the cleaning and sterilizationprocesses subject the endoscope to submersion in a liquid and to avariety of pressures and temperatures. In addition, when an endoscope isshipped by air, the endoscope is also subjected to a variety ofpressures and temperatures.

Finally, to assure that the endoscope is not damaged, the endoscope ispressure tested before each use. See for example, “Are You Properly LeakTesting Your Flexible Endoscope?”, Fibertech Medical U.S.A., 2 pgs.(2006).

The issues associated with cleaning, sterilizing, and pressure testingare known and a variety of different approaches have been taken toaddress the issues. For example, U.S. Pat. No. 5,868,667 discloses adevice that allows equalization of the pressure between an internalspace of the endoscope and an environment outside the endoscope. Thisdevice was reported to be a vent cap that equalized the pressure whilereducing the flow of any liquid, water vapor, and hydrogen peroxide intothe endoscope's internal space. The vent cap was designed to receive aport connected to the internal space of the endoscope.

However, while some manufacturers make endoscopes that include a portthat can accept a vent cap, the use of vent caps required usingdifferent caps depending on the process being used according to U.S.Patent Application Publication No. US 2014/0100425 A1. U.S. PatentApplication Publication No. US 2014/0100425 A1 describes yet anotherexample of a pressure compensation cap that can be placed on a port ofan endoscope.

SUMMARY OF THE INVENTION

A surgical apparatus, in accordance with an embodiment, includes ahousing, a pressure test chamber, and a test port retainer. The housingincludes a pressure test port. The test port retainer is mounted withinthe housing. The test port retainer couples the pressure test port tothe pressure test chamber. The test port retainer includes a test portretainer housing, a probe seal, and a liquid exclusion barrier. Theprobe seal and the liquid exclusion barrier are mounted within the testport retainer housing.

In one aspect, the test port retainer also includes a hydrophobicmembrane mounted within the test port retainer housing. In this aspect,the liquid exclusion barrier is mounted between the probe seal and thehydrophobic membrane. In one aspect, the hydrophobic membrane is apolyvinylidene difluoride membrane, while the liquid exclusion barrierincludes an X-slit valve.

The pressure test chamber includes a manifold. The test port retainer ismounted between the pressure test port and the manifold so that thepressure test port communicates with the manifold through the test portretainer.

The surgical apparatus, in accordance with an embodiment, also includesan image capture assembly. The pressure test chamber includes a centraltube having a first end, a second end, and a central lumen. The centrallumen extends between the first end and the second end. The first end ofthe central tube is affixed to the image capture assembly to form apressure tight seal. The second end of the central tube is coupled tothe test port retainer so that the pressure test port communicates withthe central lumen of the central tube through the test port retainer.More specifically, the second end of the central tube is affixed to themanifold so that the pressure test port communicates with the centrallumen of the central tube through the manifold.

The surgical apparatus, in accordance with an embodiment, also includesa pressure-sealed electrical cable. The pressure-sealed electrical cableis connected to the image capture assembly and extends through thecentral lumen into the manifold. The manifold includes a pressure seal.The pressure-sealed electrical cable extends through the pressure sealand out of the manifold.

The pressure-sealed electrical cable includes one or more conductors, afirst insulating jacket surrounding the one or more conductors, a firstshield surrounding the first insulating jacket, a second insulatingjacket surrounding the first shield, and a first pressure seal formedaround and in the first shield. In one aspect, the pressure-sealedelectrical cable also includes a second shield surrounding the secondinsulating jacket, a third insulating jacket surrounding the secondshield, and a second pressure seal is formed around and in the secondshield and extending between the second insulating jacket and the thirdinsulating jacket. The pressure-sealed electrical cable has a first endand a second end. In one aspect, the first pressure seal is adjacent oneof the first end and the second end, and the second pressure seal isadjacent an other of the first end and the second end.

An endoscope, in accordance with an embodiment, includes an imagecapture subassembly and a central tube bundle subassembly. The imagecapture subassembly (a second subassembly) includes an electrical-cableand image-capture-unit subassembly (a first subassembly). Theelectrical-cable and image-capture-unit subassembly includes anelectrical cable and an image capture unit. The electric cable isconnected to the image capture unit and extends proximally from theimage capture assembly. The central tube bundle subassembly (a thirdsubassembly) includes a central tube. The central tube has a distal end.The electrical cable is passed into the distal end of the central tubein forming the central tube bundle subassembly and the electrical cableextends from the proximal end of the central tube. The distal end of thecentral tube is connected to the image capture subassembly. The centraltube bundle subassembly also includes a light pipe coupled to the imagecapture assembly and extending through the central tube. In one aspect,the electrical cable is a pressure-sealed electrical cable.

In one aspect, the central tube is a single continuous tube with asingle lumen. The single continuous tube has an outer surface and aninner surface. The inner surface bounds the single lumen. In a stillfurther aspect, an antifriction coating coats both the outer surface andthe inner surface of the single continuous tube.

In accordance with an embodiment, the endoscope also includes a baseinstrument subassembly (a fourth subassembly). The base instrumentsubassembly includes a base, a shaft, and optionally an articulatingassembly. The shaft is coupled between the base and the articulatingassembly. The central tube extends through the articulating assembly andthe shaft. The articulating assembly is connected to the image captureassembly.

In one aspect, the articulating assembly includes a first disk, a seconddisk, an actuation cable having a distal end, and a fitting. The firstand second disks upon being mated form part of an articulation joint.The distal end of the actuation cable passes through the second disk andthen the fitting is attached to the distal end of the actuation cable.The fitting is contained in a cavity formed by mating the first disk tothe second disk.

The base instrument subassembly, in accordance with an embodiment, alsoincludes a manifold and a manifold pressure seal. The pressure-sealedelectrical cable and the light pipe pass through the manifold pressureseal, and the manifold pressure seal is mounted in the manifold. Thebase instrument subassembly also includes a test port retainer mountedon the manifold.

In another aspect, an endoscope includes a pressure-sealed electricalcable connected to an image capture unit to form a first subassembly.The endoscope further includes a shell having a distal end and aproximal end. The image capture unit is mounted in the shell from thedistal end of the shell with the pressure-sealed electrical cableextending proximally through the proximal end of the shell. A light pipehas a distal end of the light pipe being mounted in the shell with thelight pipe extending proximally through the proximal end of the shell. Alid is affixed to the distal end of the shell. The shell, lid, the lightpipe, and the first subassembly are a second subassembly.

The endoscope, in accordance with an embodiment, further includes aflange and a central tube having a distal end. The distal end of thecentral tube is mounted on the flange and the flange is affixed to theshell. The central tube, the flange and second subassembly are a centraltube bundle subassembly.

In still yet another aspect, an endoscope, in accordance with anembodiment, includes a central tube bundle subassembly and a baseinstrument subassembly. The central tube bundle subassembly includes animage capture assembly, a light pipe having a distal end mounted in theimage capture assembly, a pressure-sealed electrical cable having adistal end connected to the image capture assembly, and a central tubehaving a distal end and a lumen. The distal end of central tube isconnected to the image capture unit. The light pipe and thepressure-sealed electrical cable pass through the lumen of the centraltube. The base instrument subassembly includes a base, a shaft, and anarticulating assembly. The shaft is coupled between the base and thearticulating assembly. The central tube extends through the articulatingassembly and the shaft. The articulating assembly is connected to theimage capture assembly.

In one aspect, the central tube of this endoscope is a single continuoustube. The single continuous tube has an outer surface and an innersurface. The inner surface bounds the single lumen. An antifrictioncoating coats both the outer surface and the inner surface of the singlecontinuous tube. The pressure-sealed electrical cable has an outersurface with an antifriction coating on the outer surface of thepressure-sealed electrical cable.

In still a further aspect, an endoscope includes an image captureassembly and an articulating assembly connected to the image captureassembly. The articulating assembly includes a first disk, a seconddisk, an actuation cable having a distal end, and a fitting. The distalend of the actuation cable passes through the second disk and then thefitting is attached to the distal end of the actuation cable. Thefitting is contained in a cavity formed by mating the first disk to thesecond disk. The mating of the first and second disks forms part of anarticulation joint. The first disk is connected to the image captureassembly.

A method of manufacturing an endoscope, in accordance with anembodiment, includes assembling a first subassembly including apressure-sealed electrical cable connected to an image capture unit. Anelectrical conductivity test is performed on the first subassembly, andthen a second subassembly including the first subassembly, a shell, alight pipe, and a lid is assembled. The shell has a distal end and aproximal end. In assembling the second subassembly, the image captureunit is mounted in the shell from the distal end of the shell with thepressure-sealed electrical cable extending proximally through theproximal end of the shell. A distal end of a light pipe is mounted inthe shell with the light pipe extending proximally through the proximalend of the shell. Finally, the lid is affixed to the distal end of theshell.

After the second subassembly is assembled, a seal verification test isperformed on the second subassembly. Upon successful completion of theseal verification test, a central tube assembly is assembled. Thecentral tube assembly includes the second subassembly, a central tube,and a flange. Assembling the central tube includes mounting the centraltube on the flange, threading the pressure-sealed electrical cable andthe light pipe through the flange and the central tube, and affixing theflange to the shell.

The central tube of the central tube assembly is threaded through ashaft of a base instrument subassembly, and then the pressure-sealedelectrical cable and the light pipe are passed through a pressure seal.The pressure seal is mounted in a manifold, and the central tube isaffixed to the manifold. Finally, a pressure test is performed using aport in the manifold.

Hence, in one aspect, an endoscope includes a first subassembly, asecond subassembly, a third subassembly, and a fourth subassembly, whichare sequentially assembled and tested in making the endoscope. The firstsubassembly includes a pressure-sealed electrical cable connected to animage capture unit. The second subassembly includes the firstsubassembly, a shell, a light pipe, and a lid. The third subassemblyincludes the second subassembly, a central tube, and a flange. Thefourth subassembly includes the third subassembly, a base, a shaft, andoptionally an articulating assembly.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic side view that illustrates aspects of a surgicalsystem that includes a surgical apparatus with a pressure test port, atest port retainer, and a pressure test chamber.

FIGS. 2A to 2D illustrate alternative aspects of the surgical apparatusof FIG. 1

FIG. 3 is a more detailed schematic illustration of a test port retainerand a pressure test chamber, which are suitable for use in any of thesurgical apparatuses of FIGS. 1 and 2A to 2D.

FIGS. 4A and 4B are an end view and a cross-sectional view,respectively, of one aspect of a pressure-sealed electrical cable.

FIG. 5 is an illustration of a light pipe suitable for use in thesurgical apparatuses of FIGS. 1, 2A to 2D, and 3 .

FIG. 6 is a cross sectional view of a manifold and a test port retainersuitable for use in the surgical apparatuses of FIGS. 1, 2A to 2D, and 3.

FIG. 7A is an illustration of a central tube bundle subassembly of anendoscope.

FIG. 7B is an illustration of a base instrument subassembly of theendoscope of FIG. 7A.

FIG. 7C is an illustration of the central tube assembly of FIG. 7Ainstalled in the base instrument subassembly of FIG. 7B and aninstrument to endoscopic imaging system cable connected to thecombination.

FIG. 8 is a process flow diagram for assembling and testingsubassemblies in the assembly of an endoscope.

FIGS. 9A to 9C illustrate subassemblies used in the process of FIG. 8 .

FIGS. 10A and 10B illustrate how to modify a disk of an articulatingassembly to eliminate a possible fluid flow path.

In the drawings, for single digit figure numbers, the first digit in thereference numeral of an element is the number of the figure in whichthat element first appears. For double-digit figure numbers, the firsttwo digits in the reference numeral of an element is the number of thefigure in which that element first appears.

DETAILED DESCRIPTION

A novel structure and method, in accordance with an embodiment,eliminate the prior art shortcomings associated with a port of anendoscope that required some type of cap to seal that port. Even thougha vent cap may provide pressure compensation and block liquids fromentering the internal space of an endoscope, use of a vent cap stillrequires that a user remember to use and properly install the vent cap.If a user forgets to install the vent cap or improperly installs thevent cap, the endoscope can be damaged by liquid intrusion into theinternal space of the endoscope during sterilization of the endoscope.As described more completely below, this problem is eliminated with atest port 138 coupled to a test port retainer that is internal to anendoscope 135-1. Endoscope 135-1 is an imaging instrument, and thus maybe called instrument 135-1.

Moreover, vent caps that include a filter made from a material whichpasses gasses under pressure, but prevents liquids from passing throughmay give false positives during pressure testing. If the filter iscovered with a liquid or is wet during a pressure test, gas is blockedfrom passing through the filter, and so the pressure tester sees apositive pressure. However, this positive pressure is not the result ofinternal space of the endoscope being properly sealed, but rather is theresult of the membrane not being able to pass the gas due to themoisture on or covering the filter. Also, as described more completelybelow, not only is the reliance on a vent cap eliminated, but also, thetest port retainer coupled to test port 138 assures that no moisture orliquid blocks flow of a gas into the internal space of endoscope 135-1during pressure testing of endoscope 135-1.

FIG. 1 is a schematic side view that illustrates aspects of acomputer-assisted teleoperated surgical system 100 that includes anendoscopic imaging system 192, a surgeon's console 194 (master), and apatient side support system 110 (slave), all interconnected by wired(electrical or optical) or wireless connections 196. One or moreelectronic data processors may be variously located in these maincomponents to provide system functionality. Examples are disclosed inU.S. Pat. No. 9,060,678 B2, which is incorporated by reference herein.

Patient side support system 110 includes an entry guide manipulator 130.At least one surgical device assembly is coupled to the entry guidemanipulator. Each surgical device assembly includes an instrument thatin turn includes either a surgical instrument or an image captureassembly. For example, in FIG. 1 , one surgical device assembly includesan instrument 135-1 with a shaft 137-1 and an image capture assemblythat extends through entry guide 115 during a surgical procedure.Instrument 135-1 is sometimes referred to an endoscope, or alternativelyas an imaging system device or camera instrument. Instrument 135-1includes a novel test port retainer that connects test port 138 to amanifold in a pressure test chamber, as described more completely below,within instrument 135-1. Typically, entry guide 115 includes a pluralityof lumens.

Imaging system 192 performs image processing functions on, e.g.,captured endoscopic imaging data of the surgical site and/orpreoperative or real time image data from other imaging systems externalto the patient. Imaging system 192 outputs processed image data (e.g.,images of the surgical site, as well as relevant control and patientinformation) to a surgeon at surgeon's console 194. In some aspects, theprocessed image data is output to an optional external monitor visibleto other operating room personnel or to one or more locations remotefrom the operating room (e.g., a surgeon at another location may monitorthe video; live feed video may be used for training; etc.).

Surgeon's console 194 includes multiple degrees-of-freedom (“DOF”)mechanical input devices (“masters”) that allow the surgeon tomanipulate the instruments, entry guide(s), and imaging system devices,which are collectively referred to as slaves. These input devices may insome aspects provide haptic feedback from the surgical device assemblycomponents to the surgeon. Console 194 also includes a stereoscopicvideo output display positioned such that images on the display aregenerally focused at a distance that corresponds to the surgeon's handsworking behind/below the display screen. These aspects are discussedmore fully in U.S. Pat. No. 6,671,581, which is incorporated byreference herein.

Control during insertion of the instruments may be accomplished, forexample, by the surgeon moving the instruments and/or image captureassembly presented in the image with one or both of the masters; thesurgeon uses the masters to move the instrument in the image side toside and to pull the instrument towards the surgeon. The motion of themasters commands the imaging system and an associated surgical deviceassembly to steer towards a fixed center point on the output display andto advance inside the patient.

In one aspect, the camera control is designed to give the impressionthat the masters are fixed to the image so that the image moves in thesame direction that the master handles are moved. This design causes themasters to be in the correct location to control the instruments whenthe surgeon exits from camera control, and consequently this designavoids the need to clutch (disengage), move, and declutch (engage) themasters back into position prior to beginning or resuming instrumentcontrol.

In some aspects the master position may be made proportional to theinsertion velocity to avoid using a large master workspace.Alternatively, the surgeon may clutch and declutch the masters to use aratcheting action for insertion. In some aspects, insertion may becontrolled manually (e.g., by hand operated wheels), and automatedinsertion (e.g., servomotor driven rollers) is then done when the distalend of the surgical device assembly is near the surgical site.Preoperative or real time image data (e.g., MRI, X-ray) of the patient'sanatomical structures and spaces available for insertion trajectoriesmay be used to assist insertion.

Patient side support system 110 includes a floor-mounted base 101, oralternately a ceiling mounted base (not shown). Base 101 may be movableor fixed (e.g., to the floor, ceiling, wall, or other equipment such asan operating table).

Base 101 supports an arm assembly that includes a passive, uncontrolledsetup arm assembly 120 and an actively controlled manipulator armassembly 130. The actively controlled manipulator arm assembly 130 isreferred to as entry guide manipulator 130.

Cannula 116 is removably coupled to a cannula mount. In thisdescription, a cannula is typically used to prevent an instrument or anentry guide from rubbing on patient tissue. Cannulas may be used forboth incisions and natural orifices. For situations in which aninstrument or an entry guide does not frequently translate or rotaterelative to its insertion (longitudinal) axis, a cannula may not beused. For situations that require insufflation, the cannula may includea seal to prevent excess insufflation gas leakage past the instrument orentry guide. Examples of cannula assemblies which support insufflationand procedures requiring insufflation gas at the surgical site may befound in U.S. patent application Ser. No. 12/705,439 (filed Feb. 1,2010; disclosing “Entry Guide for Multiple Instruments in a Single PortSystem”), the full disclosure of which is incorporated by referenceherein for all purposes. For thoracic surgery that does not requireinsufflation, the cannula seal may be omitted, and if instruments orentry guide insertion axis movement is minimal, the cannula itself maybe omitted. A rigid entry guide may function as a cannula in someconfigurations for instruments that are inserted relative to the entryguide. Cannulas and entry guides may be, e.g., steel or extrudedplastic. Plastic, which is less expensive than steel, may be suitablefor one-time use.

The various passive setup joints/links and active joints/links allowpositioning of instrument manipulators to move the instruments with alarge range of motion when a patient is placed in various positions on amovable table. In some embodiments, a cannula mount may be coupled tothe first manipulator link.

Certain setup and active joints and links in the manipulator arm may beomitted to reduce the surgical system's size and shape, or joints andlinks may be added to increase degrees of freedom. It should beunderstood that the manipulator arm may include various combinations oflinks, passive joints, and active joints (redundant DOFs may beprovided) to achieve a necessary range of poses for surgery.Furthermore, various instruments alone or surgical device assembliesincluding entry guides, multiple instruments, and/or multiple entryguides, and instruments coupled to instrument manipulators (e.g.,actuator assemblies) via various configurations (e.g., on a proximalface or a distal face of the instrument transmission means or theinstrument manipulator), are applicable in aspects of the presentdisclosure.

Each of plurality of surgical device assemblies 180 includes aninstrument manipulator assembly and an instrument including one of asurgical instrument and an image capture assembly. In FIG. 1 , two of aplurality of surgical device assemblies 180 are visible, and each of thetwo visible surgical device assemblies includes an instrumentmanipulator assembly while one has a surgical instrument and the otheran image capture assembly. Each of instrument manipulator assemblies140-1 and 140-2 is computer-assisted, in one aspect, and so each issometimes referred to as a computer-assisted instrument manipulatorassembly. Each of instrument manipulator assemblies 140-1, 140-2 iscoupled to entry guide manipulator assembly 133 by a different insertionassembly, e.g. instrument manipulator assembly 140-1 is coupled to entryguide manipulator assembly 133 by insertion assembly 136-1.

In one aspect, insertion assembly 136-1 is a telescoping assembly thatmoves the corresponding surgical device assembly away from and towardsentry guide manipulator assembly 133. In FIG. 1 , insertion assembly136-1 is in a fully retracted position.

Each instrument manipulator assembly 140-1, 140-2 includes a pluralityof motors that drive a plurality of outputs in an output interface ofinstrument manipulator assembly 140-1, 140-2. Each of instruments 135-1,135-2 includes a body that houses a transmission unit. The transmissionunit includes an input interface including a plurality of inputs. Eachof instruments 135-1, 135-2 also includes a shaft 137-1, 137-2 sometimesreferred to as a main tube that extends in the distal direction from thebody. An end effector is coupled to a distal end of the shaft of oneinstrument assembly, and an image capture assembly, e.g., a camera, isincluded in a distal end of a different instrument assembly. See U.S.Patent Application Publication No. 2016/0184037, which is incorporatedby reference, for one example of an instrument manipulator assembly anda surgical instrument.

Each of instruments 135-1, 135-2 is coupled to the instrument mountinterface of a corresponding instrument manipulator assembly 140-1,140-2 so that a plurality of inputs in an input interface of thetransmission unit in instrument 135-1, 135-2 are driven by plurality ofoutputs in the instrument mount interface of instrument manipulatorassembly 140-1, 140-2. See U.S. Patent Application Publication No.2016/0184037.

In one aspect, one or more instrument manipulator assemblies may beconfigured to support and actuate a particular type of instrument, suchas instrument 135-1. As shown in FIG. 1 , the shafts of plurality ofsurgical device assemblies 180 extend distally from bodies of theinstruments. The shafts extend through a common cannula 116 placed atthe entry port into the patient (e.g., through the body wall or at anatural orifice). In one aspect, an entry guide 115 is positioned withincannula 116, and each instrument shaft extends through a channel inentry guide 115, so as to provide additional support for the instrumentshafts.

The surgeries that can be performed using surgical system 100 may beperformed on different regions of the body. For example, one surgery maybe performed through the mouth of a patient. Another surgery may beperformed between the ribs of the patient. Other surgeries may beperformed through other orifices of the patient or through an incisionin the patient. Each different entry into a patient may require adifferent shape and/or different size of an entry guide. Thus, anappropriate entry guide 115 is selected for a particular surgery.

FIGS. 2A to 2D are different aspects of endoscope 135-1. In FIGS. 2A to2D, only the aspects of endoscope 135-1 needed to understand theinventive aspects are illustrated. Some of these aspects are shown withdashed lines to indicate that the aspects are included within theendoscope.

Endoscope 235A (FIG. 2A) includes a housing 241A from which a hollowshaft 237A extends. In this aspect, connected in series to a distal endof shaft 237A are a parallel motion mechanism 270A and a wrist jointassembly 280A, which are examples of articulating assemblies. An imagecapture assembly 242A is connected to parallel motion mechanism 270A bywrist joint assembly 280A.

A test port retainer 250A connects pressure test port 238A in housing241A to a pressure test chamber. The pressure test chamber includes testport retainer 250A, a manifold 260A, and a central tube 265A.

Test port retainer 250A connects pressure test port 238A to manifold260A. When endoscope 235A is not being pressure tested, test portretainer 250A allows any pressurized gases in the pressure test chamberto be vented. Thus, there is not a possibility of pressure build-up inthe interior of endoscope 235A during the autoclave process which heatsendoscope 235A to around 140° C. or during transport of endoscope 235A.When endoscope 235A is being cleaned, either manually or in anultrasound bath, test port retainer 250A prevents any liquid or anymoisture from passing through test port retainer 250A into the interiorof the pressure test chamber.

Manifold 260A is connected between test port retainer 250A and centraltube 265A. A first end of central tube 265A is connected to imagecapture assembly 242A by a pressure tight seal and a second end ofcentral tube 265A is connected to manifold 260A by another pressuretight seal. Herein, a pressure tight seal means a seal that issufficient to maintain a minimum pressure required during a pressuretest.

Thus, in this aspect, central tube 265A is a single continuous tube witha single lumen or channel, and in another aspect is a molded singlecontinuous silicone tube with a single lumen. Central tube 256A has anouter surface and an inner surface. The inner surface bounds the singlelumen. As illustrated in FIG. 2A, a lengthwise axis of central tube 265is coincident with a lengthwise axis of shaft 237A, a lengthwise axis ofparallel motion mechanism 270A, and a lengthwise axis of wrist jointassembly 280A as central tube 265 passes through parallel motionmechanism 270A and wrist joint assembly 280A.

Typically, image capture assembly 242A includes one or more cameras andone or more illumination ports. A pressure-sealed electrical cable 261A,sometimes referred to as cable 261A, is connected to the one or morecameras and extends through the central lumen of central tube 265A andthrough a first opening in manifold 260A into an interior volume ofmanifold 260A and out of manifold 260A. Specifically, pressure-sealedelectrical cable 261A has a distal end connected to image captureassembly 242A. Pressure-sealed electrical cable 261A passes through thesingle lumen in central tube 365A, through and out of manifold 260A, anda proximal end of pressure-sealed electrical cable 261A is connected torepeater board 268A.

Pressure-sealed electrical cable 261A, in one aspect, is a shieldedcable with one or more conductors. Each of the one or more of conductorsis connected to a connector that in turn is connected to the one or morecameras. The one or more conductors are potted in the connector. Theshield or shields of cable 261 are also pressure-sealed. Herein,pressure-sealed means that a seal is formed in and around the shieldthat is sufficient to maintain the minimum pressure required during apressure test. Thus, a pressure-sealed electrical cable is a cable thatdoes not have a through path for gas flow between insulating jackets ora through path for gas flow within a part of the electrical cable, suchas the shield, which would prevent the endoscope from maintaining theminimum pressure required during a pressure test.

In this aspect, light emitting diodes on repeater board 268A are used toindicate whether a laser on. Thus, endoscope 235A includes at least onelight pipe 262A that has a first end connected to an illumination portin image capture assembly 242A and a second end potted in a metalferrule that is connected to connector 269A. Both ends of light pipe262A are mounted so that the connections are pressure-sealed. Light pipe262A extends through the central lumen of central tube 265A also.

Use of light pipe 262A is illustrative only and is not intended to belimiting. If the illuminator is included in image capture assembly 242A,light pipe 262A would not be used.

Cable 261A and light pipe 262A enter manifold 260A through a firstopening and exit through a second opening. In one aspect, a pressureseal is used around cable 261A and light pipe 262A in the first andsecond openings. In another aspect, manifold 260A is configured so thata single pressure seal is used.

Repeater board 268A is connected to connector 269A. An instrument toendoscopic imaging system cable is connected to connector 269A to coupleendoscope 235A to an endoscopic image system, such as endoscopic imagingsystem 192.

Test port retainer 250A includes a body, a probe seal 251A, a liquidexclusion barrier 252A, and a hydrophobic membrane 253A. Each of probeseal 251A, liquid exclusion barrier 252A, and hydrophobic membrane 253Aare mounted within the body of test port retainer 250A with probe seal251A being closest to pressure test port 238A and hydrophobic membrane253A being farthest from pressure test port 238A, i.e., liquid exclusionbarrier 252A is mounted between probe seal 251A and hydrophobic membrane253A.

Probe seal 251A has an opening in the center that is designed to form aseal around a tip of a pressure test probe. Liquid exclusion barrier252A is an x-slit valve, in one aspect. If there is a pressuredifferential across the x-slit valve, the x-slit valve opens until thepressure equalizes. When endoscope 235A is cleaned, the water pressureon x-slit valve is not sufficient to cause x-slit valve to open, and sox-slit valve prevents liquid from entering the pressure test chamberincluding the manifold and the central lumen of the central tube.

In one aspect, hydrophobic membrane 253A is a polyvinylidene difluoride(PVDF) membrane with 0.22 to 0.45 micrometer pore sizes. PVDF isresistant to solvents and is a highly non-reactive and purethermoplastic fluoropolymer produced by the polymerization of vinylidenedifluoride. PVDF melts at around 177 C, which is higher than thetemperatures encountered during the autoclave process. Hydrophobicmembrane 253A protects the pressure test chamber from ultra-sound fluidsand prevents any pressure build up inside the pressure test chamberduring the autoclave process.

In addition, liquid exclusion barrier 252A keeps moisture and liquidsaway hydrophobic membrane 253A so that membrane 253A operates properlyduring a pressure test. In prior art systems, if a hydrophobic membranewere wet, the hydrophobic membrane could result in a false positivepressure reading because the moisture prevented the gas used in thepressure test from passing through the hydrophobic membrane. Test portretainer 250A eliminates the likelihood of such false positive pressurereadings by preventing moisture and/or a liquid from reaching thesurface of hydrophobic membrane 253A.

To assure that there are no leaks from the environment outside endoscope235A into the pressure test chamber, a pressure test probe is insertedinto test port 238A and the pressure test chamber is pressurized to apredetermined pressure. If the pressure test chamber holds the pressureto greater than a predetermined minimum pressure for a predeterminedtime interval, there are no fluid (liquid or gas) pathways forcommunication between the environment outside endoscope and the interiorof pressure test chamber that are of significance during a surgicalprocedure. Consequently, pressure test chamber cannot be contaminatedduring a surgical procedure in which endoscope 235A is used atinsufflation pressure.

In another aspect, endoscope 235B (FIG. 2B) includes a housing 241B fromwhich a shaft 237B extends. In this aspect, an image capture assembly242B is connected to a distal end of shaft 237A.

A test port retainer 250B connects pressure test port 238B in housing241B to a pressure test chamber. The pressure test chamber includes testport retainer 250B, a manifold 260B, and a central tube 265B. Manifold260B is connected between test port retainer 250B and central tube 265B.

The configuration and construction of repeater board 268B, connector269B, test port retainer 250B including a probe seal 251B, a liquidexclusion barrier 252B, and a hydrophobic membrane 253B, manifold 260B,and central tube 265B including a pressure-sealed electrical cable 261Band a light pipe 262B are the same as repeater board 268A, connector269A, test port retainer 250A including a probe seal 251A, a liquidexclusion barrier 252A, and a hydrophobic membrane 253A, manifold 260A,and central tube 265A including pressure-sealed electrical cable 261Aand light pipe 262A, respectively. Therefore, the description of testport retainer 250A including a probe seal 251A, a liquid exclusionbarrier 252A, and a hydrophobic membrane 253A, manifold 260A, andcentral tube 265A including cable 261A and light pipe 262A is notrepeated here.

In another aspect, endoscope 235C (FIG. 2C) includes a housing 241C towhich a shaft 237C extends. In this aspect, connected in series to adistal end of shaft 237C are a parallel motion mechanism 270C and awrist joint assembly 280C. An image capture assembly 242C is connectedto the parallel motion mechanism 270C by wrist joint assembly 280C.

A test port retainer 250C connects pressure test port 238C in housing241C to a pressure test chamber. The pressure test chamber includes atest port retainer 250C, a manifold 260C, and a central tube 265C.Manifold 260C is connected between test port retainer 250C and centraltube 265C.

The configuration and construction of repeater board 268C, connector269C, parallel motion mechanism 270C, wrist joint assembly 280C,manifold 260C, and central tube 265C including pressure-sealedelectrical cable 261C and light pipe 262C, and image capture assembly242C are the same as repeater board 268A, connector 269A, parallelmotion mechanism 270A, wrist joint assembly 280A, manifold 260A, andcentral tube 265A including pressure-sealed electrical cable 261A andlight pipe 262A, and image capture assembly 242A, respectively.Therefore, the description of parallel motion mechanism 270A, wristjoint assembly 280A, manifold 260A, and central tube 265A includingcable 261A and light pipe 262A, and image capture assembly 242A are notrepeated here.

Test port retainer 250C includes a body, a probe seal 251C, and a liquidexclusion barrier 252C. Probe seal 251C and liquid exclusion barrier252C are mounted within the body of test port retainer 250C with probeseal 251C being closest to pressure test port 238C and liquid exclusionbarrier 252C being farthest from pressure test port 238C.

In another aspect, endoscope 235D (FIG. 2D) includes a housing 241D fromwhich a shaft 237D extends. In this aspect, an image capture assembly242D is connected to a distal end of shaft 237D.

A test port retainer 250D connects pressure test port 238D in housing241D to a pressure test chamber. The pressure test chamber includes atest port retainer 250D, a manifold 260D, and a central tube 265D.Manifold 260D is connected between test port retainer 250D and centraltube 265B.

The configuration and construction of repeater board 268D, connector269D, test port retainer 250D including probe seal 251D and liquidexclusion barrier 252D, manifold 260D, central tube 265D including cable261D and light pipe 262D, and image capture assembly 242D are the sameas repeater board 268C, connector 269C, test port retainer 250Cincluding a probe seal 251C and liquid exclusion barrier 252C, manifold260C, central tube 265C including cable 261C and light pipe 262C, andimage capture assembly 242C, respectfully. Therefore, the description oftest port retainer 250C including a probe seal 251C and liquid exclusionbarrier 252C, manifold 260C, central tube 265C including cable 261C andlight pipe 262C, and image capture assembly 242C are not repeated here.

FIG. 3 is a more detailed schematic illustration of test port retainer350 and pressure test chamber 370, which are suitable for use in any oneof endoscopes 235A to 235D. Pressure test port 338 in the housing of theendoscope is a first opening in test port retainer 350. Test portretainer 350 includes a probe seal 351 and a liquid exclusion barrier352, and optionally a hydrophobic membrane 353. Pressure test chamber370, in this aspect, includes a manifold 360 and a central tube 365.

Test port retainer 350 includes a first opening, which is pressure testport 338, into an interior volume of test port retainer 350. A secondopening into the interior volume of test port retainer 350 communicateswith a second opening 360-2 in manifold 360, i.e., at least a portion ofthe second opening of test port retainer 350 is coincident with secondopening 360-2 of manifold 360.

Probe seal 351 is mounted in the interior volume of test port retainer350 closest to pressure test port 338 (as measured along a lengthwiseaxis 355 of test port retainer 350 from a center of probe seal 351 to acenter of pressure test port 338) and most distance from second opening360-2 in manifold 360. Optional hydrophobic membrane 353 is mounted inthe interior volume of test port retainer 350 closest to second opening360-2 in manifold 360 (as measured along lengthwise axis 355 of testport retainer 350 from a center of hydrophobic membrane 353 to a centerof second opening 360-2 in manifold 360) and most distance from pressuretest port 338.

When optional hydrophobic membrane 353 is included in test port retainer350, liquid exclusion barrier 352 is mounted in the interior volume oftest port retainer 350 between probe seal 351 and optional hydrophobicmembrane 353. The centers of each of probe seal 351 and liquid exclusionbarrier 352 and hydrophobic membrane 353 are intersected by lengthwiseaxis 355 of test port retainer 350, in this aspect. When optionalhydrophobic membrane 353 is not included in test port retainer 350,liquid exclusion barrier 352 is mounted in the interior volume of testport retainer 350 closest to second opening 360-2 in manifold 360 (asmeasured along lengthwise axis 355 of test port retainer 350 from acenter of liquid exclusion barrier 352 to a center of second opening360-2 in manifold 360) and most distance from pressure test port 338.

Similar to the probe seals described above, probe seal 351 has anopening in its center that has a shape that forms a pressure seal arounda tip of a pressure test probe when the tip is inserted through probeseal 351. In one aspect, the shape of the opening is selected to be thesame as the cross-sectional shape of outside surface of the tip of thepressure test probe that is inserted into test port 338.

Similar to the liquid exclusive barriers described above, liquidexclusion barrier 352 is an x-slit valve, in one aspect. Also, asdescribed above for the hydrophobic membranes, in one aspect,hydrophobic membrane 353 is a PVDF membrane.

In this aspect, manifold 360 includes three openings 360-1, 360-2, and360-3. First opening 360-1 is in a flange and communicates with acentral lumen of central tube 365. A piece of heat shrink tubing is fitover a second end of central tube 365 and the second end of central tube365 is forced onto the flange. Next, the heat shrink tubing is movedover the second end of central tube and the flange and shrunk. Thecombination of the pressure fit of the central tube to the manifoldflange and the force supplied by the heat shrink is sufficient toprovide a pressure tight seal. A first end of central tube 356 is forcedon a flange that is welded to camera module 342, sometimes referred toas image capture assembly 342.

A pressure-sealed electrical cable 361, sometimes referred to as cable361, and two light pipes 362A and 362B extend in a proximal directionfrom a proximal end of image capture assembly 342. The two light pipes362A and 262B merge into a single light pipe 362 that passes through thecentral lumen of central tube 365 through first opening 360-1 into theinner volume of manifold 360. The use of two light pipes is illustrativeonly, i.e., optional, and is not intended to be limiting. In otheraspects, a single light pipe or no light pipes could be used.

Cable 361 and light pipe 362 exit the inner volume of manifold 360through third opening 360-3. A pressure seal 366 surrounds cable 361 andlight pipe 362 in third opening 360-3. In one aspect, pressure seal 366is made from a two-part, platinum-catalyzed, heat-cured siliconeelastomer. A two-part, platinum-catalyzed, heat-cured silicone elastomersuitable for use in making pressure seal 366 is sold by Dow Corning®under the tradename QP1-20 Liquid Silicone Rubber.

FIGS. 4A and 4B are an end view and a cross-sectional view,respectively, of one aspect of pressure-sealed electrical cable 361.Arrow 490 defines first and second directions. In one aspect, the firstdirection is a distal direction and the second direction is a proximaldirection.

In this aspect, cable 361 is a double shielded cable. Each of aplurality of conductors 410 of cable 361 is surrounded by its owninsulating jacket 401. A first braided shield 411 surrounds plurality ofconductors 410. A second insulating jacket 402 surrounds first braidedshield 411. A second braided shield 412 surrounds second insulatingjacket 402, and a third insulating jacket 403 surrounds second braidedshield 412. In one aspect, third insulating jacket 403 does not extendthe full length of cable 361. In one aspect, third insulating jacket 403is a silicone insulating jacket. The ends of third insulating jacket 402are removed from the ends of cable 361 to facilitate connecting cable361 to connectors 426, 425. In cable 361, the insulating jackets areelectrically insulating jackets.

Prior to connecting connectors 425 and 426 to the two ends of cable 361,a strip of outer insulating jacket 403 is removed near a first end ofcable 361 to expose the outer circumferential surface of second braidedshield 412. (In FIG. 4B, first end of cable 361 is adjacent connector425, which is an image capture unit connector.) A piece of heat shrinktubing is affixed to third insulating jacket 403 adjacent an edge of theexposed braided shield. Silicone is injected into the heat shrink tubearound the exposed outer circumferential surface of second braidedshield 412 and then the heat shrink tube is shrunk to replace theremoved strip of third insulating jacket 403. The shrinking of the heatshrink tube forces the silicone into any openings in second braidedshield 412 to form a first pressure seal 421 in and around secondbraided shield 412.

After pressure seal 421 is formed, connector 425 is affixed to thesecond end of cable 361. A first end of each of plurality of conductors410 is potted in connector 425.

To form a pressure seal in first braided shield 411 and around pluralityof conductor 410, second braided shield 412 is pushed back from a secondend of cable 361 that connects to connector 426. A strip of secondinsulating jacket 402 is removed to expose the outer circumference offirst braided shield 411. A piece of heat shrink tubing is affixed tosecond insulating jacket 402 adjacent an edge of the exposed firstbraided shield 411. Silicone is injected into the heat shrink tubearound the exposed outer circumference of first braided shield 441 andaround plurality of conductors 410. Next, the heat shrink tube is shrunkto replace the removed strip of second insulating jacket 402. Theshrinking of the heat shrink tube forces the silicone into any openingsin first braided shield and around openings between plurality ofconductors 410 and the silicone is injected around and between pluralityof conductors 410. Plurality of conductors 410 may comprise a pluralityof wires. This forms a second pressure seal 422 in and around firstbraided shield 411 and around plurality of conductors 410. Afterpressure seal 422 is formed second braided shield 412 is returned to itsproper position and connector 426 is affixed to the second end of cable361. Each of plurality of conductors 410 is potted in connector 426.

In another aspect, seals 421 and 422 are made during the process ofmanufacturing the cable. Also, in one aspect, the outer surface of allthe insulating jackets is coated with an anti-friction coating duringthe manufacturing of the cable.

FIG. 5 is an example of a light pipe 362 suitable for use in thesurgical apparatuses of FIGS. 1, 2A to 2D, and 3 . Light pipe 362includes a fiber optic bundle 501, a protective sheath 502, and aferrule 503. A first end, a distal end, of fiber optic bundle 501 issplit into two smaller fiber optic bundles 501-1 and 501-2. A second endof fiber optic bundle 501 is potted in ferrule 503

Protective sheath 502 has a first end 502-1 and a second end 502-2 thatare both open in FIG. 5 , and a third end 502-3 that is sealed to theouter circumferential surface of ferrule 503. When fiber optic bundle501 is connected to image capture assembly 342, first end 502-1 andsecond end 502-2 of protective sheath 502 are sealed within imagecapture assembly 342 so that there is not a fluid flow pathway betweenthe outer surface of fiber optic bundle 501 and the inner surface ofprotective sheath 502 that is of significance during a surgicalprocedure.

FIG. 6 is a cross sectional view of one aspect of a manifold 660 and atest port retainer 650. Manifold 660 is one example of manifold 360 andmanifolds 260A to 260D. Test port retainer 650 is one example of testport retainers 250A to 250D and of test port retainer 350.

Test port retainer 650 connects pressure test port 638 to manifold 660.Test port retainer 650 includes a body 654, a seal retainer 655, and anend cap 656. A probe seal 651, a liquid exclusion barrier 652, and ahydrophobic membrane 653 are mounted within test port retainer 650 withprobe seal 651 being closest to pressure test port 638 and hydrophobicmembrane 653 being farthest from pressure test port 638. Hydrophobicmembrane 653 is optional.

Body 654 includes an inner wall 654-3 with an opening 654-4 that isdirectly adjacent opening 660-2 of manifold 660 so that there is abi-directional fluid communication path between test port retainer 650and manifold 660. Within body 654, an O-ring 657 pushes against an outercircumferential portion of a first surface of hydrophobic membrane 653to seat an outer circumferential portion of a second surface ofhydrophobic membrane 653 against a step 654-5 that extends from wall654-3 into the inner volume of body 654.

A second end 655-2 of seal retainer 655 includes an opening 655-3. Atapered surface of seal retainer 655 holds O-ring 657 against the outercircumferential portion of the first surface of hydrophobic membrane653. A first end 655-1 of seal retainer 655 is positioned between firstend 654-1 of body 654 and a second end of end cap 656 to form the outersurface of test port retainer 650. First end 655-1 forms a groove withthe second end of end cap 656. Probe seal 651 and liquid exclusionbarrier 652 are mounted in this groove.

Probe seal 651 has a circular opening in the center, in this aspect, andis designed to form a seal around a tip of a pressure test probe. Liquidexclusion barrier 652 is an x-slit valve, in one aspect. Hydrophobicmembrane 653 is, in one aspect, a polyvinylidene difluoride (PVDF)membrane, as described above.

Probe seal 651 is an example of probe seals 251A to 251D and of probeseal 351. Liquid exclusion barrier 652 is an example of liquid exclusionbarriers 252A to 252D and of liquid exclusion barrier 352. Hydrophobicmembrane 653 is an example of hydrophobic membranes 253A to 253B and ofhydrophobic membrane 353.

End cap 656, seal retainer 655, and body 654 are welded together to forma unitary body for test port retainer 650.

Manifold 660 includes three openings 660-1, 660-2, and 660-3. In oneaspect, manifold 660 is made of a polymer formed by injection moldingpolyphenylsulfone (PPSU). Polyphenylsulfone is a heat andchemical-resistant. Polyphenylsulfone offers tensile strength up to 55MPa (8000 psi). Thus, PPSU can withstand continuous exposure to moistureand high temperatures and absorb impact without cracking or breaking.One example of a polyphenylsulfone suitable for forming manifold 660 ismedical grade Radel® R5500 resin. (Radel® is a U.S. registered trademarkof Solvay Advanced Polymers L.L.C.)

First opening 660-1 in a flange 661 of manifold 660 communicates with acentral lumen of a central tube, because the inner diameter of thecentral tube is sized so that the central tube can be force fit over theflange to form a pressure tight seal. A pressure seal 666 is mountedadjacent to third opening 660-3. A cable and light pipe (not shown) passthrough pressure seal 666 and then through third opening 660-3. Pressureseal 666 is made from a two-part, platinum-catalyzed, heat-curedsilicone elastomer. A two-part, platinum-catalyzed, heat-cured siliconeelastomer suitable for use in making pressure seal 666 is sold by DowCorning® under the tradename QP1-20 Liquid Silicone Rubber.

As explained more completely below, in assembly, light pipe 362 andpressure-sealed electrical cable 361 are passed through pressure seal666 and then this assembly is mounted in manifold 660. Next, test portretainer 650 is mounted on an end of manifold 660 that includes pressureseal 666. In this aspect, the interface between test port retainer 650and manifold 660 is stepped. Test port retainer 650 is secured to theend of manifold including pressure seal 666 so that manifold 660 exertsa radially inward force which compresses pressure seal 666 around lightpipe 362 and pressure-sealed electrical cable 361 to form a pressuretight seal. As used herein, a pressure tight seal is a seal that allowsthe pressure chamber within the endoscope to maintain a predeterminedminimum pressure that is required to pass a pressure test.

The following discussion applies to each of endoscopes 135-1, 235A,235B, 235C, and 235D. Specifically, a description of an element withrespect to FIGS. 7A to 7C, 8 , and 9A to 9C with a name that is the sameas a name of an element in endoscopes 135-1, 235A, 235B, 235C, and 235Dapplies to the element in endoscopes 135-1, 235A, 235B, 235C, and 235Dwith that name. Similarly, a description of an element with respect toendoscopes 135-1, 235A, 235B, 235C, and 235D with a name that is thesame as a name of an element in FIGS. 7A to 7C, 8, and 9A to 9C appliesto the element in FIGS. 7A to 7C, 8, and 9A to 9C with that name Thus,the correspondence between elements in the various drawings in notexpressly called out in the following description to avoid distractingfrom the inventive aspects.

Typically, a prior art endoscope used in a computer-assistedteleoperated system included a single continuous electrical andillumination bundle. The electrical and illumination components in thebundle were separate. This bundle ran from an endoscopic imaging systemto the housing of the endoscope, through the housing of the endoscope,and down the shaft of the endoscope to the distal end of the shaft. Theelectrical and illumination components followed different paths throughthe shaft to the distal end of the shaft. This endoscope was assembledin a proximal to a distal direction.

In contrast, instead of one single continuous electrical andillumination bundle that is threaded through the endoscope from anendoscopic imaging system remote from the endoscope, the endoscope isdivided into multiple testable sub-assemblies that are integratedtogether in assembling the endoscope. FIGS. 7A to 7C illustrate examplesof three subassemblies 701, 702, 703.

One subassembly is a central tube bundle subassembly 701 (FIG. 7A),sometimes referred to as central tube bundle 701 and as a thirdsubassembly. Central tube bundle 701 includes a central tube 765, animage capture subassembly 742 (sometimes referred to as a secondsubassembly), pressure-sealed electrical cable 361, and light pipe 362.In one aspect, central tube 765 is a single continuous tube with asingle central lumen. In another aspect, central tube 765 is a moldedsingle continuous silicone tube with a single central lumen. The singlecontinuous tube eliminates potential leak paths Image capturesubassembly 742 is equivalent to the image capture assemblies describedabove.

Central tube 765 is connected to image capture subassembly 742 so that apressure tight seal is formed between central tube 765 and image capturesubassembly 742. Pressure-sealed electrical cable 361 is electricallyconnected to an image capture unit within image capture subassembly 742.Ends 501-1 and 501-2 of fiber optic bundle 501 are terminated in imagecapture subassembly 742 to output light through a distal end of imagecapture subassembly 742. Pressure-sealed electrical cable 361 and lightpipe 362 are routed through a central lumen of central tube 762.

As explained more completely below, in one aspect, cable 361 and theimage capture unit are assembled as a subassembly. The image captureunit of this subassembly is inserted in a shell with cable 361 extendingthrough a proximal end of the shell in a proximal direction. The distalend of light pipe 362 is mounted in the shell with light pipe 362 alsoextending through the proximal end of the shell in the proximaldirection. A lid is affixed to the distal end of the shell and thissub-assembly is subjected to a seal verification test. Cable 361 andlight pipe 362 are then threaded through the lumen of central tube 765and central tube is affixed to the shell to form central tube bundlesubassembly 701. Central tube bundle subassembly 701 can be tested todetermine whether the camera or cameras in the image capture unit areworking properly and whether the light pipe is providing the properillumination.

Another subassembly is base instrument subassembly 702 (FIG. 7B),sometime referred to as a fourth subassembly. Base instrumentsubassembly 702 includes a base, a shaft, a parallel motion mechanism770, and a wrist joint assembly 780, in this aspect. Parallel motionmechanism 770 and wrist joint assembly 780 are each an example of anarticulating assembly. Other articulating assemblies could be used inbase instrument subassembly 702, or alternatively base instrumentsubassembly 702 may not contain an articulating assembly (see FIGS. 2Band 2D), or may contain only one articulating assembly, e.g., wristjoint assembly 780.

Base instrument subassembly 702 includes a repeater board, a manifoldsuch as manifold 660, and a test port retainer such as test portretainer 350, and a cable subassembly connector 705. Base instrumentsubassembly 702 is connected to a proximal end of shaft 757. Therepeater board includes a laser on indicator, e.g., one or more lightemitting diodes, a voltage regulator, a first connector configured toconnect to the proximal end of pressure-sealed electrical cable 361 anda second connector configured to electrically connect toinstrument-to-endoscopic imaging system cable subassembly 703. Therepeater board receives power and control signals frominstrument-to-endoscopic imaging system cable subassembly 703 (FIG. 7C)and provides these to image capture subassembly 742. The repeater boardreceives video signals from image capture subassembly 742 and providesthese video signals to instrument-to-endoscopic imaging system cablesubassembly 703.

A distal end of shaft 757 is connected to a proximal end of a parallelmotion mechanism 770. The distal end of parallel motion mechanism 770 isconnected to a proximal end of a wrist assembly 780.

A wrist joint assembly suitable for use as wrist joint assembly 780 isdescribed, for example, in U.S. Patent Application No. US 2003/0036748A1 (filed Jun. 28, 2002 disclosing “Surgical Tool Having PositivelyPositionable Tendon-Activated Multi-Disk Wrist Joint”), which isincorporated herein by reference. A parallel motion mechanism suitablefor use as parallel motion mechanism 770 is described, for example, inU.S. Pat. No. 7,942,868 B2 (filed Jun. 13, 2007, disclosing “SurgicalInstrument With Parallel Motion Mechanism”), which also is incorporatedherein by reference. Parallel motion mechanism 770 and wrist jointassembly 780 are built and the cables are tensioned in the same way asin the prior art, with the exception, in one aspect, of the most distaldisk of wrist joint assembly 780, as described below with respect toFIG. 10B.

In one aspect, a range of motion of parallel motion mechanism 770 andwrist joint assembly 780 are tested. Also, cable friction through shaft737 and friction within parallel motion mechanism 770 and wrist jointassembly 780 are tested.

After testing of subassemblies 701 and 702, central tube bundle 701 isrouted from the distal end of shaft 737 to the proximal end of shaft737. Pressure-sealed electrical cable 361 and light pipe 362 are routedthrough manifold 660 and pressure-sealed electrical cable 361 isconnected to the repeater board. The distal end of central tube 765 isaffixed to manifold 660 and image capture subassembly 742 is affixed towrist joint assembly 780. After the combining of subassemblies 701 and702, the electrical, illumination, and camera tests can be repeated toassure that nothing was damaged during the assembly process.

To complete the assembly for testing, yet another subassembly, aninstrument-to-endoscopic imaging system cable subassembly 703 (FIG. 7C),which is an example of a fifth subassembly, is connected to baseinstrument subassembly 702. The test can now be repeated using aninstrument-to-endoscopic imaging system cable subassembly 703 todetermine whether the system is functioning properly.

FIG. 8 is a process flow diagram for assembling and testingsubassemblies of an endoscope during assembly of the endoscope. InCABLE-CAMERA CONNECT process 801, each of plurality of conductors 410 ina distal end of pressure-sealed electrical cable 361 is connected to acorresponding conductor in an image capture unit 943 (FIG. 9A). In thisaspect, connector 425 on the distal end of pressure-sealed electricalcable 361 is connected to a connector on image capture unit 943. In thisexample, image capture unit 943 is a stereoscopic image capture unit,and so includes two stereoscopic cameras 944, 945. The use ofstereoscopic cameras is optional, because the assembly and testingprocess is the same if only a single camera is used. For a singlecamera, there may be a different number of conductors in plurality ofconductors 410 in pressure-sealed electrical cable 361.

A ground wire is woven into outer braided shield 412 of pressure-sealedelectrical cable 361, and then outer braided shield 412 is electricallyconnected to the body of image capture unit 943. The ground wire iselectrically attached to a ground crimp that grounds stereoscopiccameras 944, 945. The completed electrical-cable and image-capture-unitsubassembly 901, an example of a first subassembly, is illustrated inFIG. 9A.

Upon completion of CABLE-CAMERA CONNECT process 801, theelectrical-cable and image-capture-unit subassembly 901 is tested inELECTRICAL CONDUCTIVITY TEST process 802, sometimes referred to asprocess 802. In process 802, the electrical conductivity ofelectrical-cable and image-capture-unit subassembly 901 is checked bypowering stereoscopic cameras 944, 945 and observing and checking thevideo feed from stereoscopic cameras 944, 945.

Upon successful completion of ELECTRICAL CONDUCTIVITY TEST process 802,image capture subassembly 742 is assembled in CAMERA SHELL MOUNT process803, sometimes referred as process 803. In process 803, prior tomounting electrical-cable and image-capture-unit subassembly 901 in ashell 946, the distal ends of light pipes 562-1 and 562-2 are potteddirectly into enclosures in the interior of shell 946. Then,electrical-cable and image-capture-unit subassembly 901 is loaded fromthe distal end of shell 946 and arranged so that light pipes 562-1 and562-2 are on either side of image capture unit 943, as illustrated inFIG. 9B. Pressure-sealed electrical cable 361 extends in a proximaldirection from the proximal end of shell 946 as do light pipes 562-1 and562-2. In FIG. 9B, a side of shell 946 is removed so that light pipes562-1 and 562-2 and image capture unit 943 are visible. Finally, a lid947 is welded to the distal end of shell 946 to form a sealed imagecapture subassembly 742, sometimes referred to as a second subassembly.Lid 947 includes windows for each of the cameras and each of the lightpipes.

Upon completion of CAMERA SHELL MOUNT process 803, a pressure test isperformed to verify through pressure decay that the weld between lid 947and shell 946 is water tight in SEAL VERIFICATION TEST process 804. Inone aspect, the pressure testing is accomplished by creating a pressuredifferential between the inside and the outside of the shell (includingimage capture unit 943 and light pipe ends 562-1 and 562-2), andmeasuring the decay in the pressure. The orientation of the pressuredifferential does not matter.

Following successful conclusion of SEAL VERIFICATION TEST process 804,CENTRAL LUMAN ASSEMBLY process 805, sometimes referred to as process805, is performed. Prior to considering process 805, central tube 765 isfurther described. As explained above, in one aspect, central tube 765is a molded single continuous silicone tube with a single central lumen.In one aspect, central tube 765 is made of an injection molded hollowcylindrical tube that in turn is injection molded to a tapered ovalshaped tube.

In one aspect, central tube 765 is made from medical grade siliconeelastomers. Initially, a proximal cylindrical tube portion central tube765 is formed using a two-component, enhanced-tear-resistant (ETR)silicone elastomer that consists of dimethyl and methylvinyl siloxanecopolymers and reinforcing silica. Equal portions (by weight) of thetwo-components are thoroughly blended together prior to injectionmolding. The elastomer is thermally cured via addition-cure(platinum-cure) chemistry. A two-component, enhanced-tear-resistantsilicone elastomer is provided by Dow Corning under the trade nameSILASTIC® BioMedical Grade ETR Elastomer Q7-4780. (SILASTIC is a U.S.registered trademark of Dow Corning Corporation.

Next, the proximal cylindrical tube portion of central tube 765 ismolded to a distal portion of central tube 765. The distal portion ofcentral tube 765 is a molded transition between the distal end that fitsaround image capture assembly flange 966 and the proximal cylindricaltube portion of central tube 765, The distal portion of central tube 765is made using two-part platinum-catalyzed silicone elastomers. The twoparts in equal portions (by weight) are thoroughly blended togetherprior to injection molding. The elastomer is thermally cured via anaddition-cure (platinum-catalyzed) reaction. When blended and cured, theresulting elastomer consists of crosslinked dimethyl and methylvinylsiloxane copolymers and reinforcing silica. The elastomer is heat stableup to 204° C. (400° F.) and can be autoclaved. A two-partplatinum-catalyzed silicone elastomer is provided by Dow Corning underthe trade name SILASTIC® BioMedical Grade Liquid Silicone RubberQ7-4850.

In one aspect, both the inner wall and the outer wall of central tube765 are coated with an anti-friction coating. One suitable anti-frictioncoating is a Parylene-N coating. In this aspect, outer insulating jacket403 of pressure-sealed electrical cable 361 is a silicone jacket coatedwith an anti-friction coating such as a Parylene-N coating. In oneaspect, all of insulating jackets in pressure-sealed electrical cable361 are coated with the anti-friction coating. Similarly, the outersurface of protective sheath 502 including protective sheath 502-1 offirst end 562-1 of light pipe 362 and protective sheath 502-2 of secondend 562-2 of light pipe 362 is a silicone sheath coated with ananti-friction coating such as a Parylene-N coating.

Initially, image capture assembly flange 966 (FIG. 9C) is mounted in adistal end of central tube 765 in process 805. As explained above, theperimeter of the distal end of central lumen is slightly smaller thanthe outer perimeter of flange 966 so that when central tube 765 isforced on flange 966 a pressure tight seal is formed. In one aspect, apiece of heat shrink tubing is shrunk around the outer perimeter of thedistal end of central tube 765 to further assure that a pressure tightseal is formed between central tube 765 and flange 966.

Next, pressure-sealed electrical cable 361 and light pipe 362 arethreaded through flange 966 and central tube 765 to obtain the structureillustrated in FIG. 9C. The antifriction coatings on the wall of thecentral lumen of central tube 765, on outer insulating jacket 403 ofpressure-sealed electrical cable 361, and on the outer surface of sheath502 of light pipe 362 facilitates the stringing of pressure-sealedelectrical cable 361 and light pipe 362 through central tube 765 withoutthe use of force that might damage either one or both of pressure-sealedelectrical cable 361 and light pipe 362. Flange 966 is welded to aproximal end of image capture subassembly 742 to obtain central tubebundle subassembly 701, sometimes referred to as a third subassembly.

Following completion of CENTRAL LUMAN ASSEMBLY process 805, MAIN TUBEFEEDING process 806, sometimes referred to as process 806, is performed.In process 806, central tube bundle 701 is feed through wrist jointassembly 780, parallel motion mechanism 770, and shaft 737 so that theproximal end of central tube bundle 701 emerges from the proximal end ofshaft 737. The anti-friction coating on the outer surface of centraltube 765 facilitates the feeding of central tube bundle into baseinstrument subassembly 702 from the distal end of base instrumentsubassembly 702. A lengthwise axis of central tube 765 is coincidentwith a lengthwise axis of shaft 737, parallel motion mechanism 770, andwrist joint assembly 780, in this example.

Following completion of MAIN TUBE FEEDING process 806, MANIFOLD ASSEMBLYprocess 807, sometimes referred to as process 807, is performed. Inprocess 807, a piece of heat shrink tubing is slid over the proximal endof central tube 765 and then the proximal ends of pressure-sealedelectrical cable 361 and of light pipe 362 are threaded through opening660-1 in flange 661 of manifold 660. Next, the proximal ends ofpressure-sealed electrical cable 361 and of light pipe 362 are threadedthrough the corresponding channels in pressure seal 666 and pressureseal 666 is mounted in the end of manifold 660 opposite to flange 661.Test port retainer 650 is mounted on manifold 660 and screws are used totighten test port retainer around manifold 660 so that manifold 660compresses pressure seal 666 around pressure-sealed electrical cable 361and around light pipe 362 to form a pressure tight seal.

The circumference of the proximal end of central lumen is slightlysmaller than the outer circumference of flange 661 so that when theproximal end central tube 765 is forced on flange 661 a pressure tightseal is formed. In one aspect, the piece of heat shrink tubing is shrunkaround the outer circumference of the proximal end of central tube 765to further assure that a pressure tight seal is formed between centraltube 765 and flange 661.

Finally, to complete process 807, the proximal ends of pressure-sealedelectrical cable 361 are connected to the repeater board in baseinstrument subassembly 702. Following completion of, MANIFOLD ASSEMBLYprocess 807, sometimes referred to as process 807, CENTRAL LUMENPRESSURE TEST AND DISTAL ILLUMINATION TEST process 808 is performed.

Prior to considering CENTRAL LUMEN PRESSURE TEST AND DISTAL ILLUMINATIONTEST process 808, the rationale for the pressure test is considered.Detection of a breach large enough to pass blood into the pressurechamber of the endoscope when pressurized at insufflation pressure,approximately 15 mmHg, is needed for patient safety. Due to surfacetension, there will be some minimum hole size, below which insufflationpressure is not be able to force blood through the breach. However, airflow through the breach occurs at some level, regardless of the holesize. Therefore, the method of assuring that there is not a breach largeenough to pass blood as insufflation pressures is to pressurize thepressure chamber in the endoscope to a predetermined pressure, such as150 mmHg, and to observe whether pressure falls below a predefinedminimum pressure during a predetermined time interval. If the pressuredoes not fall below the predefined minimum pressure at the end of thepredetermined time interval, the endoscope is deemed not to have abreach that would pass blood into the pressure chamber volume whenpressurized at insufflation pressure. This is a worst case assessment,as the pressure test interrogates all breaches, including those toosmall to allow blood to pass. The details of the pressure test aredetermined empirically by assessing the leak rates of different breachesand their corresponding blood flow properties.

In CENTRAL LUMEN PRESSURE TEST AND DISTAL ILLUMINATION TEST process 808,a test probe is inserted in the pressure test port of the endoscope, andthe pressure test chamber, as defined above, is pressurized to apredetermined pressure, e.g. 150 mmHG. If the pressure test chamberholds the pressure to greater than a predetermined minimum pressure,e.g., 40 mmHg, for a predetermined time interval, e.g., 30 seconds,there are no fluid pathways at insufflation pressure for communicationbetween the environment outside endoscope and the interior of pressuretest chamber that are of significance during a surgical procedure.Consequently, pressure test chamber cannot be contaminated during asurgical procedure in which the endoscope is used at insufflationpressure. In the illumination test, properties such as opticaltransmission of the light pipe and the number of unbroken illuminationfibers are measured.

In one aspect, a distal disk 1081 (FIG. 10A) of wrist joint assembly 780is welded to the proximal end of image capture subassembly 742 afterMAIN TUBE FEEDING PROCESS 806. A plurality of wrist actuation cables areconnected to distal disk 1081. One actuation cable 1082 of the pluralityof wrist actuation cables is shown in the cutaway diagram of FIG. 10A.Actuation cable 1082 enters distal disk 1081 from a through hole in aproximal end surface of distal disk 1081 and extends into a slot 1081A.A crimp fitting 1083, which is an example of a cable end fitting, on thedistal end of actuation cable 1082 is positioned in slot 1081A in distaldisk 1081 of wrist joint assembly 780. (A cable end fitting is sometimesreferred to as a fitting.) Slot 1081A extends in the proximal directioninto distal disk 1081 from a distal end surface of distal disk 1081. Toblock a potential leak path from the distal end of slot 1081A proximallyaround crimp fitting 1083 and around cable 1082 to the outsideenvironment, in this aspect, slot 1081A is filled from the distal endwith a room temperature vulcanization silicone to encapsulate crimpfitting 1083 and to fill the open volume of slot 1081A.

In another aspect, the need for filling slot 1081A and encapsulatingcrimp fitting 1083 is eliminated. In this aspect, distal disk 1081 issplit into two distal disks 1081-1 and 1081-2 of wrist joint assembly780. Disk 1081-2 is referred to as second distal disk 1081-2 because itis the second disk from the distal end of wrist joint assembly 780. Disk1081-1 is referred to as first distal disk 1081-1 because it is thefirst disk at the distal end of wrist joint assembly 780.

A plurality of wrist actuation cables for wrist joint assembly 780 areconnected to the mated combination of first distal disk 1081-1 andsecond distal disk 1081-2. One actuation cable 1082 of the plurality ofwrist actuation cables is shown in the cutaway diagram of FIG. 10B.

Actuation cable 1082 pass through a through hole extending from aproximal end surface of second distal disk 1081-2 to a distal surface ofsecond distal disk 1081-2. Actuation cable 1082 extends into a slot1081B in first distal disk 1081-1. A crimp fitting 1083 on the distalend of actuation cable 1082 is positioned in slot 1081B in first distaldisk 1081-1 of wrist joint assembly 780. Slot 1081A extends in thedistal direction into first distal disk 1081-1 from a proximal endsurface of first distal disk 1081.

Outer circumferential distal end surface 1081-1DS of first distal disk1081-1 is welded to the shell of image capture subassembly 742. An outercircumferential edge distal edge surface 1081-2DS of second distal disk1081-2 is welded to outer circumferential proximal edge surface 1081-1PSof first distal disk 1081-1. There is no longer a leak path around crimpfitting 1083 and around cable 1082 to the outside environment becausefirst distal disk 1081-1 blocks any leak path to the volume inside thepressure chamber. Crimp fitting 1083 is encapsulating in a volumecreated by the mating of first distal disk 1081-1 to second distal disk1081-2 and there is no path of significance during a surgical procedurebetween the pressure test chamber and the volume created by the matingof first distal disk 1081-1 to second distal disk 1081-2.

Thus, as illustrated in FIG. 10B, an articulating assembly includes afirst disk 1081-1, a second disk 1081-2, an actuation cable 1082 havinga distal end, and a crimp fitting 1083. Actuation cable 1082 passesthrough second disk 1081-2, and crimp fitting 1083 is attached to thedistal end of actuation cable 1082. Crimp fitting 1083 is contained in acavity formed by mating of first disk 1081-1 to second disk 1081-2.

As used herein, “first,” “second,” “third,” “fourth,” etc. areadjectives used to distinguish between different components or elements.Thus, “first,” “second,” “third,” “fourth,” etc. is not intended toimply any ordering of the components or elements or any particularnumber of components or elements.

The above description and the accompanying drawings that illustrateaspects and embodiments of the present inventions should not be taken aslimiting—the claims define the protected inventions. Various mechanical,compositional, structural, electrical, and operational changes may bemade without departing from the spirit and scope of this description andthe claims. In some instances, well-known circuits, structures, andtechniques have not been shown or described in detail to avoid obscuringthe invention.

Further, this description's terminology is not intended to limit theinvention. For example, spatially relative terms—such as “beneath”,“below”, “lower”, “above”, “upper”, “proximal”, “distal”, and thelike—may be used to describe one element's or feature's relationship toanother element or feature as illustrated in the figures. Thesespatially relative terms are intended to encompass different positions(i.e., locations) and orientations (i.e., rotational placements) of thedevice in use or operation in addition to the position and orientationshown in the figures. For example, if the device in the figures isturned over, elements described as “below” or “beneath” other elementsor features would then be “above” or “over” the other elements orfeatures. Thus, the exemplary term “below” can encompass both positionsand orientations of above and below. The device may be otherwiseoriented (rotated 90 degrees or at other orientations) and the spatiallyrelative descriptors used herein interpreted accordingly. Likewise,descriptions of movement along and around various axes include variousspecial device positions and orientations.

The singular forms “a”, “an”, and “the” are intended to include theplural forms as well, unless the context indicates otherwise. The terms“comprises”, “comprising”, “includes”, and the like specify the presenceof stated features, steps, operations, elements, and/or components butdo not preclude the presence or addition of one or more other features,steps, operations, elements, components, and/or groups. Componentsdescribed as coupled may be electrically or mechanically directlycoupled, or they may be indirectly coupled via one or more intermediatecomponents.

All examples and illustrative references are non-limiting and should notbe used to limit the claims to specific implementations and embodimentsdescribed herein and their equivalents. Any headings are solely forformatting and should not be used to limit the subject matter in anyway, because text under one heading may cross reference or apply to textunder one or more headings. Finally, in view of this disclosure,particular features described in relation to one aspect or embodimentmay be applied to other disclosed aspects or embodiments of theinvention, even though not specifically shown in the drawings ordescribed in the text.

We claim:
 1. A system comprising: an image capture assembly; anarticulating assembly connected to the image capture assembly, thearticulating assembly comprising a first disk, a second disk, anactuation cable having a distal end, and a fitting, the distal end ofthe actuation cable passing through a first opening in the second disk,the fitting being attached to the distal end of the actuation cablepassing through the first opening in the second disk, the fitting beingcontained in a cavity formed by mating the first disk to the seconddisk; and a central tube extending internal to and through thearticulating assembly, including extending through a central opening inthe first disk and a central opening in the second disk, wherein theactuation cable is external to the central tube, wherein the centraltube defines an internal lumen, wherein the central tube is connecteddirectly to the image capture assembly on one end such that apressure-tight seal is formed to prevent leaks from the internal lumenof the central tube to an external environment, and wherein the firstdisk is connected directly to both the image capture assembly and anoutside surface of the central tube to prevent leaks from the internallumen of the central tube and the image capture assembly to the externalenvironment.
 2. The system of claim 1, wherein the actuation cable isone of a plurality of actuation cables connected to the matedcombination of the first disk and the second disk.
 3. The system ofclaim 1, wherein the fitting is a crimp fitting.
 4. The system of claim1, wherein the actuation cable extends into a slot in the first disk. 5.The system of claim 4, wherein the slot extends in a distal directioninto the first disk from a proximal end surface of the first disk. 6.The system of claim 1, wherein an outer circumferential distal edgesurface of the second disk is mated to an outer circumferential proximaledge surface of the first disk.
 7. The system of claim 6, wherein thefirst disk and the second disk are mated through welding.
 8. The systemof claim 1, wherein the first disk is connected to the image captureassembly through welding.
 9. The system of claim 1, wherein thearticulating assembly is a wrist joint and the first and second disk areat a distal end of the wrist joint.
 10. The system of claim 1, furthercomprising: a parallel motion mechanism coupled to a proximal end of thearticulating assembly.
 11. The system of claim 1, wherein the centraltube is a single continuous silicone tube and the internal lumen of thecentral tube is a single continuous lumen.
 12. A system comprising: animage capture assembly; an articulating assembly connected to the imagecapture assembly, the articulating assembly comprising a disk, anactuation cable having a distal end, and a fitting, the distal end ofthe actuation cable passing through a first opening in the disk, thefitting being attached to the distal end of the actuation cable passingthrough the first opening in the disk, the fitting being contained in aslot in the disk; and a central tube extending internal to and throughthe articulating assembly, including extending through a central openingin the disk, wherein the actuation cable is external to the centraltube, wherein the central tube defines an internal lumen, wherein thecentral tube is connected directly to the image capture assembly on oneend such that a pressure-tight seal is formed to prevent leaks from theinternal lumen of the central tube to an external environment, andwherein the disk is connected directly to both the image captureassembly and an outside surface of the central tube to prevent leaksfrom the internal lumen of the central tube and the image captureassembly to the external environment.
 13. The system of claim 12,wherein a sealant encapsulates the fitting and fills an open volume ofthe slot.
 14. The system of claim 12, wherein the actuation cable is oneof a plurality of actuation cables connected to the disk.
 15. The systemof claim 12, wherein the fitting is a crimp fitting.
 16. The system ofclaim 12, wherein the slot extends in a proximal direction into the diskfrom a distal end surface of the disk.
 17. The system of claim 12,wherein the disk is connected to the image capture assembly throughwelding.
 18. The system of claim 12, wherein the articulating assemblyis a wrist joint and the disk is at a distal end of the wrist joint. 19.The system of claim 12, wherein the first opening is formed in aproximal end surface of the disk.
 20. The system of claim 12, furthercomprising: a parallel motion mechanism coupled to a proximal end of thearticulating assembly.